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On its own, ulcerative colitis, a type of inflammatory bowel disease (IBD), is enough for you to handle. But one symptom — bleeding in your intestine — may, in turn, lead to a second condition needing treatment, anemia.

Anemia can happen if you lose a significant amount of iron, which is an important component of red blood cells. As a result, you can get an iron deficiency. Without iron, your bone marrow can't make needed red blood cells, causing iron deficiency anemia.

This can become a vicious cycle, requiring both medical and nutritional attention, said Michael Wald, MD, MS, CDN, director of nutritional services at Integrated Medicine of Mount Kisco in Mount Kisco, N.Y.

A Less Usual Course of Events

For Lyn Nelson, 28, of Rye, N.Y., a diagnosis of iron-deficiency anemia came first, back in 2005. Her doctor was unsure of the cause and began treating her with iron supplements, but when Lyn was diagnosed with ulcerative colitis the following year, the cause of the anemia became clear — her IBD.

Though Nelson's ulcerative colitis is causing her anemia, she doesn't physically feel any daily correlation. "I don’t have a flare-up of the anemia when I feel a flare-up of the colitis," she said. "The anemia is just constantly there, but as long as it is treated and my iron levels continue to increase, I don’t feel the same ebb and flow of symptoms that I do with the colitis."

Though digestive tract conditions often cause anemia, the symptoms of ulcerative colitis and anemia are very different. Symptoms of ulcerative colitis include diarrhea, blood or mucous in your stool, gas, cramping, constipation, weight loss, loss of appetite, fever, and skin lesions.

Symptoms of iron anemia may include fatigue, a feeling of uneasiness, muscle aches and pains, heart palpitations, difficulty thinking, and lightheadedness. You might also have a pale complexion.

Nelson experiences fatigue and lack of stamina from the anemia — it's especially noticeable when she tries to exercise for a lengthy time, but she experiences some overlap, too. "These symptoms can also occur with ulcerative colitis, but it brings a host of other symptoms that the anemia doesn’t, including stomach pain and cramping as well as irregular, frequent, and urgent bowel movements," she said.

Getting Treatment

Because anemia is a symptom and not a disease per se, your doctor needs to treat the cause of your anemia within the context of treating your IBD.

If your anemia is due to blood loss, your treatment should focus on stopping the bleeding. If the anemia is due to an iron deficiency, then your doctor will advise taking vitamin B12 or folic acid and may suggest eating foods that are high in iron.

Ulcerative colitis is usually treated with medications that reduce inflammation. Commonly prescribed drugs include mesalamine and sulfasalazine. Sometimes stronger medications to suppress the body’s immune system are required, including steroids, azathioprine, and a class of medications known as anti-tumor necrosis factor (TNFs) drugs. Examples include infliximab or adalimumab. For extreme cases of ulcerative colitis, surgery may be advised, Dr. Salomon said.

Nelson continues to take iron supplements for anemia. "I learned the hard way that iron supplements can be very hard on your digestive system," she said. "The first few pills I took worsened my colitis symptoms significantly." She now takes time-release iron tablets, which work much better. They include vitamin C, which aids in absorption.

For her ulcerative colitis, Nelson takes mercaptopurine (6-MP) and mesalamine as a maintenance drug.

Management and Coping Strategies

If you properly manage ulcerative colitis and anemia, it doesn't have to rule your life. However, "you may have to accept some permanent lifestyle choices in terms of diet, stress management, and nutritional supplements," Wald said.

"The key to happiness is to accept that there will be ups and downs if you have these diseases, no matter what you do," Salomon added.

Nelson shared these three strategies that have helped her:

Learn everything you can. The Crohn’s and Colitis Foundation of America has a wealth of information. Nelson, a member and volunteer, uses its printed resources and attends its conferences whenever possible. "It is tapped into a great network of doctors (which is how I found my current GI) and have accurate and up-to-date information," she said. "The more I learn about my conditions and treatments, the more in control I feel."

Consider telling your circle of friends and family. "It can be difficult to tell people about IBD. No one wants to hear about your bowel movements," Nelson said. "But the stress of figuring out how to cope on your own in a classroom, party, theater, office, and so forth can just make your symptoms worse. Now I consider everyone a part of my team, and they all understand if I have to drop what I’m doing to run to the bathroom. My quality of life improved dramatically when I felt like everyone was understanding and supportive of my needs and actions."

Have a sense of humor. "It can be incredibly demoralizing to have little-to-no control over your own body, and learning how to laugh about it helps you realize that flares end and life goes on," said Nelson. "It’s easier said than done, but it’s what people notice about me, and it’s how I know I’ve gotten through a number of difficult times."

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